| NPI | 1255560223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25ma09992600) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 33376) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 276803) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2022-07-21 |